The Bio-Psycho-Social Interaction: Exploring Mental Health in the Black Community

Hello and welcome. I'm Dr Itunu Johnson-Sogbetun, and today in partnership with Osmosis I'm giving this webinar on the biopsychosocial interaction exploring mental health in the Black community so a bit about me I'm a UK based what we call general practitioner I know in the US you call it a family physician and in my work I really prioritize the biopsychosocial interaction in health now a bit about my American credentials so I did my medical elective at the University of Chicago Medical Center a few years ago now and so it was actually there that I had my first encounter in an academic perspective on health inequity because I don't know how many of you know Chicago well but the southside of Chicago is not far from High Park which is where the University of Chicago Medical Center is and I remember hearing this frightening statistic at the time where it was said that the chances of dying in childbirth in High Park was some of was the one of the lowest in the world so they had some of the best maternal Health Care but in the south side of Chicago just six or seven blocks away the chances of dying in child birth were some of the highest in the world H and comparable to parts of sub-Saharan Africa and this was really where my interest in health in equity was kindled anyways I've developed clinically and I have become an expert I have a special interest in women's health menopause Care Mental Health and of course Health Equity advocacy and here in Northwest London I lead the equity diversity and inclusion at the Royal College of general practitioners which is kind of like our board and I work to enhance Health equality and I've also founded Health Equity and advocacy learning which is called heel and we'll talk about that a bit more later on okay so what are we going to talk about I mean we all know that mental health disparities within the Black community is a pressing issue so we're going to do a deep dive into the factors affecting mental health in the Black community and consider the biopsychosocial aspects in addition we're going to be really deep looking into the unique biological aspects that impact mental health in the Black community look at some of the psychological factors that contribute to the disparities and explore the social aspects that influence mental health outcomes and emphasize an intersectional approach in addressing these disparities okay so we'll just start with the personal narrative so I'm obviously a British a British educated but I wasn't born in England I was born in Nigeria and lived there till I was 15 years old and actually when I was growing up I remember when I was about 9 or 10 a relative was diagnosed with schizoaffective-affective disorder and this was a really important moment in my childhood because it was my first engagement with serious mental illness but at the time there was a real lack of understanding and about what was going on and that LE that led to misinterpretation of her behavior and she herself and also other members of the family were a bit there was a delay in seeking Professional Health there was also the thought about some of the Supernatural and religious causes and we'll talk about this because this is really a big thing in the Black community when it comes to religious causes or religious support when undergoing mental illness and there was sort of that adding to the hesitation to seek assistance promptly and that impacted the trajectory of her illness and I remember she was in and out of hospital for quite a while until she accepted that this was a mental illness and she needed to be on medication and when she was on medication the trajectory changed but it did take a while for us to get to that point and this reflects the reality for many Africans and people of African descent which emphasizes the urgent need for us to advocate for understanding and reduced stigma of mental health in the community okay so there are other myths we've talked about the spiritual attribution Mi myth so from the story that I just told you mental health issues can be wrongly linked to spiritual causes leading to religious Solutions like Deliverance or exorcism but there's also other myths like there's a strength misconception believing that mental illness signifies weakness and this is really something that we need to challenge then there's also the therapy is for white people quote unquote which again is a barrier to accessing help although thankfully this is changing but this is something that certainly was a feeling within particularly the older Generation then there's the violence stereotype which is a very harmful stereotype that Associates mental illness with inherent violence and unpredictability and then there's the stability doubt which is a misconception that once an individual has been diagnosed with the mental illness including serious mental illnesses they can't lead a stable life and that undermines recovery possibilities because we know that that is not true okay so now let's just set the scene so obviously for the vast majority of you you're based in the United States so we need to think about the historical context and things like slavery and exclusion that has led to present day socioeconomic disparities for Black communities so following slavery there was the Jim Crow era which enforced racial segregation particularly the in the southern parts of the United States which fostered constant stress fear and violence and contributed to mental health challenges in the Black community and the effect of that has been poverty homelessness incarceration and substance use which elevates the risk of poor mental health so all of these things layer on it doesn't exist in a vacuum unfortunately these historical enduring historic historical impacts still shape the current mental health landscape for Black individuals so again the socioeconomic status is so tied in with mental health we know that e economic hardships correlate with higher rates of poor mental health amongst African-Americans but also if someone has a mental health condition if they have come from a lower socio economic background then they're less likely to have a better outcome so they're more likely to have poorer outcomes and then there's that lingering effect of racism and we're going to explore some of this in the psychological aspects of mental health in the Black community which is ongoing negative stereotypes and mistrust from historical mistreatment adversely affect in the mental well-being of African-Americans and then there Geographic disparities so there's over representation in impoverished rural areas especially in the South but we know that a lot of the people from the South moved into some of the Midwest cities and so there's some really big Urban hubs where there's a lot of poverty there's a lot of mental illness there's a lot of substance abuse and all of this compounds mental health challenges because there's limited resources and support available for these individuals now looking at the interplay of the biological the psychological and social aspect it's all interacting and so that's kind of what we want to explore so when we think about the biological aspects we think about genetics epigenetics and physiological function now genetics is inherited traits that's what we get from our parents so that's you know a predisposition towards mental illness can be inherited and we'll talk about that in a minute but epigenetics something that I really want you to try and get your head around which is the study of heritable changes in gene function that impact gene expression and traits so actual life events can cause chemical changes on genetic material and this is termed epigenetic changes which can influence traits and even transfer across generations for example The Offspring of Holocaust Survivors and those exposed to the Dutch famine exhibited health issues that span multiple generations and we see similar in descendants of slaves and segregation and racial discrimination that these stress ores impact their experience of mental health and even physical health as well so as I said we can inherit genetic variations that heighten susceptibility to Mental Health disorders and we know that conditions like schizophrenia and bipolar are very strongly running in families and there's a strong genetic predisposition association with that we also know that from twin studies however the gene expression contributes to disparities and what we can see is that we see that when someone has experienced stresses in their childhood when they get if they get bipolar disorder then the symptoms are worse than it would have been and are for longer and so the trajectory of their illness is worse so these epigenetic interactions can heighten an already existing genetic predisposition and can then translate to Future Offspring through these transgenerational epigenetic changes so what we're talking about is impacting multiple generations and this is why what we can do to positively impact that is so important because it can make a difference not just for that patient but for future Generations okay so again thinking about the biological aspect so Black communities have higher PTSD rates due to racial trauma African-American youth are at significant risk of PTSD with nearly 65% reporting trauma Black Americans are 20% more likely to experience serious mental distress and it suicide rates is rising faster in Black men and even Black women compared to their white counterparts and factors like age gender and comorbidities contribute to higher mortality rates and disparities IM morbidity amongst African-Americans so not only are there is there a disparity in Mental Illness but there's a disparity in physical illness and we know that there's higher rates of disease such as heart disease diabetes cancer INF infant mortality all of those things can then add an extra layer because they themselves can then feed into adding to mental health challenges so there's the physical health challenges that is more common so some of these conditions are more common in the Black community we know that autoimmune diseases are also more common in Black women and these disparities then lead to mental health challenges so it's kind of like then becomes a chicken and egg situation where the physical health problems are driving mental health problems which are then driving physical health problems and it becomes a real difficult challenge to unpack and this can lead to cognitive disorders mood disorders psychosis and even increased risk of dementia and then we know that mental functioning can be affected by opportunistic infections substance misuse and some of the side effects of the medications that might be used for these physical health conditions as well so these can contribute to the biological aspects of mental health issues now the psychological aspect so I think it's really important to understand that we cannot overstate the impact of race racism discrimination and microaggressions now the daily microaggressions that a lot of Black people fac in in the world and in the work environment and socially cause this situation that we refer to as minority stress and that can be a Kindle to mental illness and the impact of historical racism and discrimination as we've discussed have impact not just currently but also potentially for future Generations as I've mentioned before so we cannot understate this now individuals reactions to racism encounters are heavily influenced by their cultural identities and I really want us to have a think about this because a the Black population is not a monolith there are loads and loads of different groups within the Black population and for example you could have two African-Americans but one of them is a second generation Kenyan American or and the other one is a an African American whose ancestors were slaves so their cultural identities are very different and therefore they might react differently to racist encounters and also those experiences might impact their self-esteem and their coping mechanisms so it's important to understand that that self-esteem and cultural identity can really affect how people are able to manage when they have a mental illness and it there really isn't a one-sized fits all approach there's a variability within the Black community. furthermore we know that the systemic discrimination leads to persistent anxiety and DEP and depressive symptoms but racism impact on mental health is complex it's not as simple as it's there's no it's not simple because each individual is different and so each individual is going to react differently based on their psychology their own previous experiences their childhood experiences that the modeling that they saw in older Generations so that their modeling from when they were growing up all of these different factors the support networks that they have their self-esteem their personality so many different interplays so we can't make an assumption on how a person is going to react but we know the evidence shows that racism and systemic discrimination makes it more challenging for the vast majority of Black individuals so it's really important that when we are creating psychological treatments and providing psychological treatments that we have this cultural context and personalized culturally competent care and we'll talk about this later on in the talk now there's also some there's a phenomenon known as stereotype threat that affects Black individuals cognitive performance via negative stereotypes awareness so I'll give you an example so for example a Black woman may be aware of the fact that there's a stereotype that Black women are considered to be more aggressive and therefore she then tries to pull her curtail herself and not express herself to the fullness of her ability because she's worried about that stereotype and therefore she does herself a disservice and she doesn't fully F fulfill all that she could have potentially given to that situation and this is a situation that I've seen loads of women go through from the Black community because they are threatened by The Stereotype and so they are acting in response to that threat and we see this in so many different ways and it can impact people's mental health and mental well-being then also there's constant exposure to racial bias can actually internalize negative beliefs sorry can internalize negative beliefs influencing self-esteem so for example like a young African-American male who has who just hears about negative stereotypes negative beliefs about violence and believes that you know what's the point this is what Society expects of me and that influences his self-esteem and he therefore you know he doesn't have posit if he doesn't have positive role models and people encouraging him that he can be whatever he wants to be then he might just feel it's easier to just go with the racial bias that he's experienced something like that and then coping mechanisms deter developed to navigate stress can be positive and can be negative and they can impact thought processes as well so negative coping mechanisms like substance abuse avoidance so I also term religious avoidance as one of the ways in which so a lot of people might run to the church or the mosque or their place of faith and say you know I that's you know and avoid the situation of what's going on with their mental health or with their mental well-being self-harm and risky behavior can further harm mental health so we want to be trying to promote positive coping mechanisms and encourage people to develop that rather than the negative coping mechanisms but this again starts with the psychology of how they view themselves okay so socioeconomic factors really so now we're talking about social aspects and socioeconomic factors and limited resource contribute to poorer outcomes and so we know that income in inequality and lack of educational opportunities increase vulnerability and a lot of this is a systemic issue and it's really important that we Advocate from a systemic point of view because these changes is not just in mental Health it's also in the physical health and also in just the general well-being and development of Black people that these things need to be improved and all of that change in the social in the social socioeconomic factors can then ultimately improve mental well-being in the Black community so those are some of the systemic issues but one of the things that is can be effectively lifechanging and it really is supportive social networks Community engagement which helps build cultural resilience this has a big protective role in mental health Management in the Black community and this is where we this is something that we know there's the evidence for it and we need to Foster this so because we know that when people have support they do better with their mental health and when they don't have support they do worse that's what the evidence shows so again Community ties are really important and we're going to be you know talking about that a bit more now income inequality is huge and it's still the case that in two 2022 the typical African American family had only 16 cents for every dollar compared to the typical white family and I mean it's huge the this the disparity is huge so this wealth Gap really underpins a lot of the vulnerability and the and the disparities in in health inequity in the Black community and so this is something that we need to be working to widen sorry to narrow and reduce because the impact is clear we are seeing the repercussions of that okay so now thinking about social aspects so studies suggest that divorced or never married individuals may experience high levels of depression and divorce and lack of spousal support can contribute to increased stress and mental health challenges now Black adults exhibit the highest divorce rate and the lowest marriage rate and Black women are the sole group where the number of divorces surpass the marriage rate amongst the different races so this is inversely so basically this is one of the one of one of the big reasons why we see worsening when Black people get depression we have they have worse manifestation because this social isolation and social support is inversely related to depression levels so the more you are isolated and the more you're alone the higher your risk of getting depression and for you to have severe depression symptoms now there's also the lack of access to Quality educational opportunities and job opportunities and this is still seen we we've mentioned about the Financial inequality and then there's Dee rooted historic injustices such as the Tuskegee syphilis study so this was a study that was done where Black people were knowingly given syphilis in order to investigate and this you know the Black people without their consent and this contributes to a legacy of mistrust amongst Black communities because there's a gap between the medical establishments and the Black community there's a gap in trust and that does mean that people are can a little bit hesitant to seek help from traditional medical facilities now and then this racial disparities in health care access because again there is differences in the quality of Health Care that the Black community receives and Healthcare that is available in in areas where there are more Black people generally tends to be of less quality and this reinforces the distrust and this can lead to delayed help seeking behaviors which can exacerbate mental health challenges amongst Black individuals now Black individuals so this is the impact that we see Black individuals below the poverty line are twice as likely to report serious psychological distress Black teenagers have a higher suicide attempt than white teenagers adult Blacks Black people experience more feeling of sadness hopelessness and worthlessness than white adults and over the B past decade serious mental illness has risen amongst Black individuals of all ages and so this is obviously something that we want to stop in its track and reverse the trend so let's say hello to Aisha is a 45 year-old Black woman who lives in Chicago where she's employed as a janitor she was diagnosed with schizophrenia 25 years ago and hypertension 4 years ago she has remained stable on her medications and despite being a single mother she struggles to manage the responsibility of raising her three children all the while embracing her Muslim identity so Aisha has an intersectionality in her mental health challenges so there's race there's gender there's comorbidity and there's socioeconomic status so the combination of age and gender complicates Aisha's mental health needs as she's a middle-aged Black woman who is single she's a single mother of three as this caring responsibilities add stress and that limits her time for self-care and amplifies her mental health challenges now for Aisha her Muslim identity is really important and actually she has found it to be quite supportive and she has a community with where she goes to worship and that Community has really supported her and although she's always been open to medical support the support from her religious community is equally if not more important to her and actually she has found that she feels that that's where she gets the most support from now Aisha has encountered social isolation in terms of being single which is worsened by her divorce and lack of financial means so she has to work very hard she has some support from Social Services to help with the children and to help her but she has Financial limitations and that sometimes means that she's had to rely on charity and support from her community to afford necessary Health Care services and she's also encountered biases so because they know she's got schizophrenia, sometimes people expect her to they expect she can tell that their expectation of her is not what they when they meet her and she can tell that they have some biases about her or about her how she should present and this sometimes causes a difficulty in her relationships with her medical practitioners and the cumulative effect of these can worsen Aisha's me mental state you can see how we can see the different layers of complexity so there's the so there's all the issues with her physical and mental health but then there's all the fact that she's single mom there's the fact that she has caring responsibilities there's the fact that she has Financial strain and all of those things make it very difficult but there's other intersectionalities that can layer on mental health disparities and I just wanted to touch on these as So Physical disabilities can create even more barriers being an immigrant or Refugee status can lead to intensified stress and trauma sexual orientation so being from the LGBTQIA-plus community there added layers of stigma and discrimination which can exacerbate mental health illnesses and then incarceration as well can heighten trauma and limit mental health support so back to Aisha so we need to consider the biological which is her medication and her physical health so she's got schizophrenia and sorry excuse me she's got schizophrenia and hypertension but psychologically how is she coping so she has some support from her so from her religious support network which has really helped and that's one of her main coping strategies so she that that provides her with a lot of the support that she needs and that's part of the that helps with her psychology because she doesn't feel as alone as she would have been and then finally that social support from her religious cultural background so is part of the support network that she has that actually has helped her so the medical the mental health and the social work professionals all work together and need to work together in order to provide Optimum care for a patient like Aisha because she's going to need social support Social Work support particularly to empower her to Be an Effective mother so not trying to say because you know she can parent her children with support and so this is one of the challenges is that just because someone has a mental illness doesn't mean they can't parent their children of course we don't want to put children in spaces that are unsafe but it can you know with adequate support and someone like Aisha she has been stable and she can be supported to look after her family so that's part of where Social Services can come in the mental health Team and obviously her medical team support her with chronic illness because we also know that having had long-term schizophrenia she's at higher risk of a lot of the chronic diseases like hypertension diabetes heart disease and so on so again Aisha's Muslim identity is really important to her so it's important that it's respected she does see it as one of the fundamental parts of how she's managing to cope and this must be respected the social supports are continuing to enhance her social connections and community resources but advocacy is really important because we need to seek systemic changes to address some of the societal issues because people like Aisha say for example if she didn't have her religious community she could really get she could have really struggled more with social isolation and being lost into the system so it's really important that we have systemic structures to provide the support that people like Aisha need okay so strategies for addressing mental health disparities in the Black community so promoting mental health awareness and education to reduce stigma so that's reducing stigma in the in the Black community but also empowering members of the healthcare professional to challenge their own biases as well and that's part of what we're doing here that's why we're having this conversation enhancing access to Affordable culturally sensitive services and we'll be talking more about culturally competent care it's really important actually because that the difference between someone coming back to for help H can be that culturally sensitive approach and then again we have to keep mentioning about advocating for policy changes and empowering communities because it all falls apart without community support network cannot be overstated so we need to build resistance and Foster social support so we need to build social cohesiveness because that's a key part of mental resilience and mental health recovery for a lot of people and collaboration and Partnerships with faith-based organizations so one of the key things in the literature is that for a lot of PE Black people especially for the older generation faith-based organizations are really key so we need to think how can we work alongside them to provide the support that they need Charities Healthcare Providers and policy makers so it's going to need all of us working together to try and improve care okay so I just wanted us to Spotlight this Village Arrow Village project so looking for Solutions of what has worked in the past so this is actually a project that was set up in the 1950s by the first Western trained psychiatrist in Nigeria so his name was Dr Thomas Lambo and he came up with a very Innovative idea where facing resource constraints he converted employment employee housing into a day Hospital complex to provide mental health care and patients were housed in villages with family members assisting in their care and the project completely transformed societal perspective of mental illness and really demonstrated how you can provide effective community-based quality mental health care despite resource limitations now so there was tackling space funding and resources so overcoming limitations to provide this care then it was an intersection of politics and healthcare it was a win-win for the for the local politicians and also win-win for the healthcare service because they were able to provide accessibility community- based support at reduced costs it was socially responsive so because it utilized members of the community it reduced societal stigma around mental illness and kind of normalized caring for people in the community with mental illness and destigmatized mental illness then there were the flexible payment schemes so people donated in cash and in kind so for those who didn't have cash they donated their time or they donated their resources so it wasn't so people could donate with whatever they had and that meant that it was more sustainable and we saw trans tangible results and effective psychiatric care and this was loaded all around the world again it was an inclusive environment provide promoting supportive spaces for individuals and at the very core of it was Community engagement and sustainable Solutions which demonstrated the potential for its long-term for long-term Improvement in mental health care access but it's unfortunate that this Innovative system has not been replicated as far as we're aware and it worked so well at that time but unfortunately it really wasn't the model wasn't really continued and I think that has to say about how our communities have changed and how there's been a lot of breakdown in community because this was such a really good way of being able to look after mental mentally ill patients in their own communities and provide that adequate support at a high level so I represent an organization called heel what do we do heel T tackles urgent African and Black Health Equity issues primarily through education and advocacy addressing challenges in healthcare Access we promote mental health awareness we try and reduce stigma and enhance access to Affordable culturally sensitive services so we're very passionate about educating people about culturally competent care and we'll be talking about that in a minute advocating for policy changes we aim to dismantle systemic barriers affecting Health Equity and we want to empower our communities and build resilience so that's what we're trying to do with heel now what's your part what's your part what can you do so you're doing it now you're training to learn about the unique mental health needs of the Black community you are but you also need to learn to establish inclusive systems wherever you're working for diverse patients not just Black patients but for a diversity of patients and develop Outreach programs for mental health education and resources so really try and recreate that that trust within the Black community and the medical professionals so go out there create trust get to know the community and participate in campaigns to reduce mental health stigma and open up conversations this is stuff that you can do at where whatever stage you are in your training now it's really important that we encourage representation of Black individuals in medical and mental health Fields because we want diverse voices we want diverse insights and we want diverse Solutions so the more diverse the workforce the more representative it is of the population that they serve and the better the outcomes and then also engage in advocacy for policies and use your platforms to raise awareness about mental health in the Black community emphasize help seeking and reduce barriers to services so it all starts from your little corner so you can make a change so cultural I just wanted us to focus in the last few minutes about cultural competency so this is how I break it down is clinical curiosity taking an interest in your patients? lives and not just their symptoms so it's not just somebody who came in with Mania but try and understand what is their context integrated trauma informed care so respect and include cultural factors and an understanding of potential added challenges with minority trauma into Healthcare discussions to align with the patient's background so it's personalized it's not just you know it's not a one-sized fits all approach it must respect and include cultural factors open communication Foster a judgment and Foster a safe and judgment free space for the patient to openly discuss concerns experiences and expectations so no so that the patient can fully share their thoughts if they really believe that it's a supernatural cause that is causing their mental illness it's more important that they're able to express that to you and then you can have that conversation and challenge it rather than creating a judgmental space where they don't feel open and able to express these concerns symptom recognition so actively listen to and acknowledge the symptoms you because it's really important because a lot of the time there's Medical gaslighting in the back community and people feel that their symptoms are not picked up or listened to education and awareness so again providing clear and culturally sensitive information on potential causes diagnosis and treatment options so in conclusion be brave so B is for biopsychosocial awareness acknowledge the biological the psychological and the social factors of mental health we've touched on those of course this is such a huge topic we don't have the time to talk about every single thing you rela in but we've talked about talked about that so you can learn more Explore More recognition of diversity so recognize that the Black community is not a monolith and there are diverse experiences and there's needs of intersecting identities there are multiple layers this is complex and it should be handled with the complexity that with respect for the complexity that it deserves actionable strategies so practical approaches for awareness accessibility advocacy and Community empowerment and then valuing the contribution so really try and make sure that we try and work together with individuals with communities religious organizations to prioritize Black mental health and Empower so this is all about empowering individuals and communities to manage their own mental health to seek help and to be empowered in the decision making process so thank you for listening I hope you've had enjoyed the talk and any questions we have a question here curious to know that if racism race-based traumatic stress racial trauma was never a part of the DSM and has been referred to as an injury versus disorder how Dependable are the Western Eurocentric modalities to offer support and treatment I think this is a fantastic question because at the end of the day I mean I think that people have been more open to thinking about some of these things and the how they inform or impact mental health illness but it you know it hasn't historically been something that in the medical establishment they have really put a lot of impact on and so this is why we're having these conversations because again that's why culturally competent care is so important how do we Target our treatment for how do we target our treatment for these individuals who are impacted by race dis racism discrimination that is impacting their mental health we have to understand the context it's got to be the psychological aspect and that's why as I said you cannot this is a biopsychosocial approach you can't just approach it from one perspective because otherwise you'll be doing the patient a disservice so I think there's a greater appreciation and understanding for the complexity of it and the approach whether it's going to make into the DSM that's probably a question that that I I'm not sure but certainly it's something that is being thought about a lot more and it's something that certainly there's a lot more conversations about now I hope that answers your question so what does it look like to in include churches and spiritual leaders into the mental health space so I think it's this really this is a really important question because you know there are pitfalls on both sides of how to handle this so I think that it's not necessarily so we can work with faith-based organizations providing evidence-based and support so we you know that that's something that can happen but of course we need to be careful about some of the Falls where there are things that are not evidence-based and are not a clinical clinically factual or accurate ways of managing mental health conditions so again it's walking that fine line and I think actually it's the patient it's not really up to us it's what the patient wants so here's the thing if the patient wants to engage with the church or the mosque or the religious organization then you know we support them in doing that but give them the information that they need to be able to navigate those pitfalls but as a healthcare organ you know as Health Care Professionals you know I'm willing to work with anyone who is going to Pro help provide better health care as long as I know that they're not going to be doing anything to violate evidence-based medicine and the principles of or are going to provide are going to be doing anything that's discriminatory or against the law or any of those sorts of things so of course you have to do some kind of if we if you're going to be partnering with a Fai faith-based organization there needs to be a protocol in place for what that looks like to make sure that it's evidence-based and it's it doesn't fall into a pitfall but it's certainly something that can be done and I think you know W would be helpful for parts of the Black community because this is for a lot of people this is one of their main resources their church or their mosque or their religious community okay how can we locate your organization here such as your website or even okay so you can so you can email me at my email address is [email protected]. you can email me about that okay now question spirituality related do you believe or have you looked at any data that this new health wealth and prosperity say it and claim it gospel is also further contributing to this spirituality aspects of the poor African-American mental health outcomes and across the entire American Nation in general especially when we know that unfortunately us whom are of any African-American descent in which we know the education disparities also exist which would contribute to the belief in a false hope so obviously I can't necessarily comment on any specific Doctrine or anything like that but I would say that you know there is a lot out there that within religious communities that might not be the safest of spaces and there's a lot of church abuse we have to remember that so again these are the kind of things that we need to filter for if we're going to be working with any organization and also put safeguards in place if we're going to be working or recommending in that recommending that we work with a certain religious organization because there is you know definitely some parts of Faith world that takes advantage and can be catastrophic for people's mental health and I've certainly seen that but that doesn't mean that you know they're not very good religious organizations out there that can help Provide support but we're not you know we're medical so at the end of the day it's not we're not making a judgment on someone's religious beliefs we're trying to help someone have good mental health so again it's supporting them and giving them the information and providing them creating that line of trust so that they're able to share their concerns with us we're able to provide them with accurate information with cultural competent care so that's what we're looking at rather than making a judgment on their faith in particular because that's not really our REM okay what types of educational programs do you believe would be especially beneficial for these communities especially ones that are lower income with less resource for instance would it would it help to for them to learn about this is from a Public Health perspective so I certainly think that you know the basics of how to look after your mental health mental health F Aid how to manage anxiety how to manage low mood those sorts of courses can be really helpful because they can provide people with basic skills of how to look after their own mental health so there's and then understanding about more of the complexities about so they can learn about more serious mental illnesses so they can pick out the symptoms because you know sometimes people are not even aware of what the symptoms of things like OCD are or symptoms of things like Mania they may not be aware so again that education about what are these conditions how you know how where do you go for help signposting people to culturally competent resources be really helpful as well okay religious avoidance as a coping strategy okay so what I meant by religious avoidance was I meant that you know not wanting to engage and instead you know say for example some people have serious mental illness and instead of going for treatment they would say oh I'm going to the church and that is you know avoiding treatment for something that needs actual medication now again obviously the person is well within their if that's their belief and that's their right you know that's their right to express that belief but again it's about understanding where they're coming from why do they have those beliefs and challenging them and finding a way to reach them to explain to them the benefits of medication and treatment and even showing them positive stories or positive outcomes from the Black community on people who have had treatment and who are better I think those sorts of things are ways in which we can encourage and educate now you know I'm not against as I said repeatedly I'm not against faith-based support or faith-based mental health and as long as it matches up with evidence-based care so it's not contradicting evidence-based medicine or evidence-based psychiatric care now oh any thought this is a good question any thoughts about in including indigenous medicine when it comes to treatment if we're considering cultural competence this a really good question because I think it's important to have a respect so I'm not trained in indigenous medicine so in in my country in Nigeria well in my where I was born in Nigeria there's also native medicine and again this is something that people look to when they are faced with challenges in mental health conditions so I'm not trained in indigenous or native mental health treatments so I can't comment on them in terms of from a clinical perspective what I can say is I would ask why is the person seeking that treatment what understanding do they have about it because sometimes these medications don't contain what they say they contain a lot of the time we don't know what's in them a lot of the time they can interact with other medications so I think it's just challenging that from a from a place of care not judgment and you know explaining the risks but also trying to if they're insistent that this is what they want to have try and see how we can support them in having it whilst providing them still with good care because whatever you know we have we need to try and support our patients with you know with their choices it's their individual choice they are you know individuals we can't impose our own will on them but we can really try and provide that non-judgmental supportive personalized care so I think it's to find out why are they looking for that you know is there anything that we can provide support to that might be helpful in order to address that specific need maybe there's a need for why they're seeking the indigenous or native care that we can meet if you know that may be possible and if not then we can find out you know really say okay what is this medication what you know what is in it we just want to make sure that it's not going to do you any harm and coming from that perspective rather than a judgmental perspective okay any tips on navigating ethical policies that are rooted in colonialism and racism that may prevent Black and Brown practitioners from growing deeper in advocacy and leaning into ways of being that in reality goes against how some of the okay I think that question is trying to ask how do we advocate in sometimes hostile environments and I think you know at the end of the day I think you my personal approach is to try and not be offended and you know keep pushing you know keep knocking at the door and keep being persistent because you know not everyone is going to see this as a big issue even though of course it is but some of us in the Black and Brown communities will be more aware because it's our lived experience and we've seen family members or friends or neighbors experience some of these inequities so again you know I think my personal feeling is that you are more likely to win with honey rather than something more bitter so I try and you know I try and be you know keep being persistent but you know if someone doesn't I if someone's not interested I leave it for a while and then and then find other Avenue you know I keep knocking on different doors because this issue is important and we need to keep at it but it's not always going to be easy and I appreciate some of your I understand some of your frustration no thank you so much I'm sorry I haven't been able to answer all the questions I did try to answer as many as I could within the time available but time is up now it was really wonderful so I think my contact details have been shared please feel free to get in touch if you have any questions I'll be happy to answer them so thank you so much for coming helping current and future clinicians Focus learn retain and thrive.